TBHI Q&A #17: How should we deal with Tarasoff when practicing telebehavioral or telemental health over state lines?
If a therapist is doing Telehealth with a patient/client and its originating site is in a state that follows the Tarasoff law, and the therapist’s site is not in a state that follows Tarasoff, would the therapist still need to follow Tarasoff since it’s the law in the jurisdiction of the patient that matters?
— Armand J., MD
Tarasoff and Licensure Portability / Interjurisdictional Practice
Thank you for this question. Yes – the jurisdiction of the patient at the time of the contact is the one that typically rules the activity of the therapist. The location of the clinician is typically not the deciding factor. However unwieldy compliance may be, state boards expect that all clinicians working in a state be aware of and compliant with all relevant laws in that state. While the boards often have contradictory laws and regulations from one state to another, and often don’t make it easy for a clinician to abide by such laws, most states haven’t yet changed in this regard.
If unclear about a state’s laws and regulations, the clinician is always wise to contact their own board and that of the state where the client/patient is located at the time of the treatment before proceeding. Please note that in contacting a state that doesn’t respond to such inquiry, it may be useful to send a registered, return receipt letter informing the state board in question that you’ve tried emailing and calling their number several times regarding interjurisdictional practice, without response. You may also want to respectfully ask them to make themselves available to respond to inquiries about this matter, or change their laws and regulations and keep you informed of such changes.
Important to Complain to the Involved Boards
It may seem as if your letter goes nowhere, but indeed, state boards are examining these issues closely at this point. Every well-written, respectful letter tends to be discussed and often given great weight. One of the biggest problems to date is that regulators are not hearing directly from licensees about their outdated laws and regulations. Given the lack of complaints about barriers to licensure portability, boards attend to other issues. It may help to know that the function of a licensing board in the United States tends to be reactionary, and not proactive. In many states, boards then must respond to complaints, and in doing so, spend their funds on handling existing complaints rather than anticipating and preventing complaints related to new and emerging areas.
The proliferation of Internet Startup Services who Regularly Disregard Licensing Issues
The lack of funded purview for boards to pole/educate themselves and their licensees is the crack that has allowed many Internet start-up companies to proliferate unfettered in their attempts to recruit licensees who are unaware of the many ways in which they are in violation of their state laws when working online for large, well-funded money-making operations (Glueckauf, Maheu, Drude, Wells, Wang, Gustafson, Nelson, 2018). Complaints rule with licensing boards. File yours today if you have one.
Also please note our use of qualifiers: “typically” and “usually.” There can be an outlying state that wants something else to happen, but the norm is as we described above.
Clinicians need to contact all boards, understand, and abide by their rules. When those laws conflict, the clinician would be wise to follow the most restrictive of the relevant rules. For information about competencies needed, professionals are referred to the Telebehavioral Health Institute professional CE training or for shorter webinar recordings, see this TBHI webinar page.
TBHI is delighted to sponsor the TBHI Q&A Series in its blog. Interspersed with our other news and features, TBHI will post a question obtained from one of our Trainees. One such question will be drawn and answered regularly. While we can’t answer each question individually, we will try our very best to respond to all your queries. Send us your inquiries/concerns by dropping an email here and mention your wish to have the question posted on our blog.
Glueckauf, Robert L.; Maheu, Marlene M.; Drude, Kenneth P.; Wells, Brittny A.; Wang, Yuxia; Gustafson, David J.; Nelson, Eve-Lynn. Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, Vol 49(3), June 2018, 205-219.